护士主导的肺部超声检查评估心源性肺淤血的准确性研究

Nurser-provided lung ultrasound assessment in patients with heart failure

目的评估重症监护室护士应用肺部超声(LUS)检查B线筛查心力衰竭(心衰)患者肺淤血的可行性及准确性。方法入选2023年3月至8月期间在中国医学科学院阜外医院心衰重症监护病区(HFCU)住院的心衰患者,由经规范化超声培训的重症监护室护士和医师分别应用LUS检查B线评估肺淤血情况(以双侧胸腔8分区B线≥10定义为肺淤血),计算Kappa值,评价操作者间筛查肺淤血的一致性。采用受试者特征曲线(ROC)评价重症监护室护士获得B线图像的能力及解读B线图像的准确性。结果共入选94例心衰住院患者,医师判断肺淤血患者66例,重症监护室护士识别肺淤血患者67例,筛查肺淤血的敏感度97%,特异度89%,曲线下面积(AUC)值为0.931,约登指数为0.863,Kappa值为0.872。结论经规范化培训的重症监护室护士应用LUS检查B线识别心衰患者肺淤血与医生检查结果的一致性较高,是一种可行的诊疗模式。

Objective To evaluate the feasibility and accuracy of lung ultrasound(LUS)screening for pulmonary congestion in patients with heart failure(HF)by nurses in intensive care unit.Methods Patients hospitalized with HF in Heart Failure Care Unit,Fuwai Hospital,Chinese Academy of Medical Sciences from March 2023 to August 2023 were enrolled.Pulmonary congestion which was defined as the number of B line no less than 10 for 8-zone in bilateral chest was assessed by using of LUS by an intensive care unit(ICU)nurser or doctor after receiving standardized ultrasound training independently.The consistency of screening for pulmonary congestion between nurser and doctor was evaluated by calculating the kappa value.Moreover,receiver characteristic curve(ROC)method was used to evaluate the ability of ICU nursers to obtain B-line ultrasound images of lungs and the accuracy of interpreting B-line ultrasound images of lungs.Results A total of 94 inpatients with HF were enrolled.Of note,66 patients was identified with pulmonary congestion by the doctor while 67 patients were considered with pulmonary congestion by the nurser.Compared to the screening results obtained by doctor,the screening sensitivity and specificity for pulmonary congestion by nurser was 97%and 89%,respectively.The area under the curve(AUC)value was 0.931,and the Jorden index was 0.863,and the Kappa value was 0.872.Conclusions Standardized trained ICU nurser can identify pulmonary congestion in HF patients by using of LUS to measure B-line with high consistency with doctor,which is a feasible diagnosis and treatment model.